Reducing Seclusion and Restraint in Texas

“Seclusion and restraint” is using physical force, restricting movement, or involuntarily medicating or isolating people to manage their behavior. These methods often are used to control people at risk of harming themselves or others in settings such as juvenile detention centers, psychiatric hospitals, residential treatment facilities and schools.

The use of seclusion and restraint is a complex, controversial issue that touches many Texas agencies. Use of seclusion and restraint is considered a failure in treatment because it can be traumatic and dangerous to consumers and staff. It can cause severe physical and psychological harm, and even death. It can also lead to mistrust and power struggles that conflict with a positive therapeutic environment and hinder recovery.

Residential Treatment Centers Funding Initiative

The Hogg Foundation awarded a three-year grant in the amount of $589,172 to Texas Network of Youth Services to provide technical assistance to residential treatment centers (RTC) implementing trauma-informed systems of care to reduce their reliance on seclusion and restraint.

As part of this project, the Hogg Foundation hosted two training seminars on trauma-informed systems of care - one in Houston and one in Austin. The seminars were led by national experts on trauma-informed care, Beth Caldwell, MS; Kevin Ann Huckshorn, RN, MSN, CADC, ICRC and Janice Lebel, PhD. These trainings were offered to staff from all residential treatment centers in Texas in January 2012.

Texas Network of Youth Services will provide intensive technical assistance and follow-up support to selected residential treatment centers for up to three years after the training seminar.

Through this initiative, the Hogg Foundation hopes to:

Raise awareness of the prevalence and influence of trauma in the lives of RTC residents and the ways in which trauma affects behavior.
Highlight the ways in which the use of seclusion and restraint pose the risk of causing further traumatic experiences and examine the complex relationship between trauma and behavior.
Demonstrate the significance of and need for cultural change at every level of an organization in order to successfully implement trauma-informed practices that reduce the use of seclusion and restraint.

Reducing Restraint through Trauma-Informed Care for People with Intellectual Disabilities and Behavioral or Mental Health Conditions

Traumatic experiences affect both brain development and behavior. Individuals with intellectual disabilities are at much higher risk than the general population of abuse, neglect and the associated trauma. Behaviors caused by trauma can create challenging and sometimes dangerous situations for the individual and the support staff assisting those with intellectual disabilities. These challenging behaviors are often attributed solely to the disability with minimal attention to the individual’s mental health.

The Hogg Foundation is partnering with the Department of Aging and Disability Services to provide training and technical assistance on trauma informed care to service providers supporting individuals with intellectual disabilities. Understanding the impact of trauma on behavior and using trauma-informed strategies can help reduce the use of restraint on individuals with intellectual disabilities in both facility and community settings.

The foundation coordinated trainings at two state supported living centers in February 2012. Both facility staff and community service providers were invited to participate. As organizations begin to plan and implement new strategies learned at the trainings, the foundation will offer on-going technical assistance to support the restraint reduction efforts.

Conferences and Training Events

The Hogg Foundation for Mental Health supports efforts to identify effective, safe alternatives to seclusion and restraint techniques through research, policy discussions and education. Since 2004, the foundation has hosted conferences, sponsored training for agencies across Texas, and provided educational materials about reducing the use of seclusion and restraint.

2007 Conference (training materials and presentations online)
2006 Training Institute (training materials and presentations online)
2006 Teleconference (training materials and presentations online)
2004 Robert Lee Sutherland Conference (training materials and presentations online)

Texas Seclusion and Restraint Leadership Group

The Hogg Foundation also launched and facilitates the Texas Seclusion and Restraint Reduction Leadership Group. Formed in 2007, the group’s members include mental health consumers, family members, advocates and representatives of private and public agencies. They have the expertise and experience to help bring about organizational change and can be a knowledgeable resource and guide to state lawmakers, agencies, advocates, service providers and consumers.

The leadership group also serves as advisors for a federally funded project called STARS: State of Texas Alternatives to Restraint and Seclusion. The project was funded with a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to the Texas Health and Human Services Commission and Department of State Health Services to focus on reducing seclusion and restraint to four Texas psychiatric hospitals. It became evident that many of the tools used to change the culture of care and reduce restraint and seclusion in state mental hospitals could be applied in other care settings as well so a toolkit for creating a trauma-informed environment was developed by the Texas Department of State Health Services.

Brochure: It's Time for Positive Change: Reducing Seclusion and Restraint in Texas

Leadership Group Contacts

Dr. Lynda Frost